Real time clinical decision support system having medical systems as display elements

ABSTRACT

A clinical decision support system for patient treatment that incorporates patient data to display information in readily identifiable icons for vital organs and medical systems, and in a useable, real-time, updated fashion that extracts data from the medical history, the current medical management, the current physiologic monitors, and associated medical systems to produce warnings and alerts to enable caregivers to be made aware of physiologic systems at risk. These data are not only presented, but also use real-time queries and calculations to enable caregivers to have the types of data that would traditionally assist them in patient care but only be available by reviewing the medical literature and/or doing retrospective individual calculations while providing patient care.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 12/900,533 filed on Oct. 8, 2010, which claims the benefit ofU.S. Provisional Application No. 61/295,829, filed on Jan. 18, 2010 andU.S. Provisional Application No. 61/249,801, filed on Oct. 8, 2009. Theentire disclosure of each of the above applications is incorporatedherein by reference.

FIELD

The present disclosure relates to clinical decision support systems and,more particularly, relates to real-time clinical decision supportsystems capable of extracting data from medical history, current medicalmanagement, currently employed medical systems, and/or currentphysiological monitors and providing real-time alerts related thereto.

BACKGROUND AND SUMMARY

This section provides background information related to the presentdisclosure which is not necessarily prior art. This section alsoprovides a general summary of the disclosure, and is not a comprehensivedisclosure of its full scope or all of its features.

The opportunity for this new unique type of clinical decision supportsystem has been brought about by the expansion of the electronic medicalrecord. Historically, physiology data have all been displayed inelectronic fashion and, in some cases, at least some of the data can bestored. More recently, the patients' medical history data are beingcollected in an electronic format. Some of those data collection systemssupply those data in a structured format (relational database) thatallows fields to be queried. Additionally, over the past decade,anesthesia intraoperative records have become available in electronicformat. Initial efforts in producing an electronic anesthesiainformation system (known as AIMS) started in the 1980s; the technologywas not mature and not widely adopted until relatively recently.Currently, there is a minimum of eight or more systems being marketedaround the world.

In the perioperative and acute care ICU environment, these data are nowavailable in real-time. The impetus for the present teachings is theincorporation of all these data to display information in a readilyuseable, real-time, updated fashion that extracts data from the medicalhistory, the current medical management, known medical systems currentlyoperable in connection with the patient, known therapies, includingmedications, currently impacting the patient, and the currentphysiologic monitors to produce warnings, alerts, signals, reminders,recommendations, or instructions to enable caregivers to be made awareof physiologic systems at risk, (physiologic systems in normal range,borderline normal range, and abnormal range of function). The presentteachings also provide other intelligent indicia determined, gathered,calculated, or otherwise ascertain to provide warnings, alerts, signals,reminders, recommendations, or instructions to a caregiver in light of aplurality of data and known factors. That is, these data are not onlypresented, but also use real-time queries and calculations to enablecaregivers to have the types of data that would traditionally assistthem in patient care but only be available by reviewing the medicalliterature and/or doing retrospective individual calculations whileproviding patient care.

It should be appreciated that the principles of the present teachingsenable additional factors, such as devices or implantables that interactwith various organs within the patient body, to be actively monitoredand considered in determining patient care. In many cases, these devicesare not just passive monitoring physiologic signals, but are alsoactively interacting with the body or other biological system of thepatient. For example, a cardiac bypass machine actively pumps bloodthrough the cardiovascular system when the heart is stopped duringspecific operations. There are situations where the presence of such adevice or implantable may not be readily apparent to caregivers; forexample, a pacemaker could be implanted within a patient without itspresence being immediately known.

It should also be appreciated that the principles of the presentteachings enable additional factors, such as drugs or therapeutics thatinteract with various organs within the patient body to be activelymonitored and considered in determining patient care. In many cases,these drugs are interacting with the body or other biological system ofthe patient. Current display devices typically just communicate when adrug was administered, alert if a dose was forgotten or if there arepotential counter-indications, such as allergies, or indicate that adrug is part of a regimen this patient is currently self-administering.There are situations where the impact of a drug on a specific organsystem may not be readily apparent or where the impact of the drug onthe patient body or biological system may not be clearly understood whenemploying conventional systems.

Unfortunately, current display devices do not provide context as to thestatus of these devices or implantables. It should be appreciated thatinformation relating to whether these medical devices or implantablesare malfunctioning, turned off, or in some other non-functioning statecould provide useful information in patient diagnosis and treatment.But, often times, that information is not readily apparent, nor is itdisplayed alongside the display device that shows the monitoring signalfrom the organ or organ systems that is monitoring the patient.

Moreover, in the current practice of medicine there exists a large bodyof information, including clinical references, protocols, and guidelinesthat help to aid a caregiver in the treatment of patients. However, dueto the breadth of such information, it can be difficult to quicklyobtain such information during time-sensitive periods of patienttreatment. The present teachings enable automated access to clinicaldocumentation during treatment through on-screen alerts, reminders, andlinks to clinical references, protocols, and guidelines.

According to the principles of the present teachings, in someembodiments, the display system can comprise several general concepts.First, the display can have readily identifiable icons for each of thevital organs—brain, lung, heart, kidneys, liver, skin, and the body—andalso related medical systems—mechanical ventilators, pacemakers, and thelike. Second, these readily identifiable icons can move in real-timewith the input of real-time physiologic data and medical systemoperational conditions. For example, the heart beats in real-time withthe patient's heartbeat provided by the physiologic monitor and thelungs expand and retract (ventilate) in real-time with the physiologicdata provided from the monitoring system and anesthesia machine (airwaypressures). Third, the icons can be color coded to signify theparameters are in various ranges, such as a normal range being depictedin the color green, a marginal range being depicted in the color yellow,and an abnormal range being depicted in the color red.

In some embodiments, the icons can be color-coded orange (or any otherindicia) if that organ system is at risk, given that patient'sindividual history that is associated with a specific risk for thatorgan. For example, if the patient has significant risk factors forpostoperative myocardial infarction (heart attack) the rim around theheart can be the color orange alerting the caregiver that this patientis at risk.

Finally, in some embodiments, the display system of the presentteachings can provide pop-up alerts, or other alerts, when a combinationof events occurs which produces a situation where there could be apossible important physiologic or medical system abnormality that couldpotentially cause risk or harm to the patient.

The color coding risk analysis and pop-up alerts will be described belowunder the specific organ system sections. However, it should beappreciated that variations can be made to the color, indicia, or otheralert protocol without departing from the scope of the presentteachings.

Further areas of applicability will become apparent from the descriptionprovided herein. The description and specific examples in this summaryare intended for purposes of illustration only and are not intended tolimit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only ofselected embodiments and not all possible implementations, and are notintended to limit the scope of the present disclosure.

FIG. 1 is a schematic diagram and a screen capture image of a real-timevisual alert display illustrating icons for the brain, tracheobronchialtree, lungs, heart, major vessels (aorta, vena cava), and body withtemperature, hematocrit, and glucose with kidneys on either side eachbeing indicated in a medium gray color (equivalent to the color green inthe present figures) representative of all major organ systems being intheir normal range.

FIG. 2 is a screen capture image similar to FIG. 1 illustrating a darkgray color (equivalent to the color red) outlining the heart icon and alower right corner of the heart icon indicating that the alert displaysystem detected ST segment changes consistent with possible ischemia ofthe myocardium.

FIG. 3A is a screen capture image similar to FIG. 1 illustrating anormal cardiac filling volume and also notes that the temperature isbelow the normal range, signified by the light gray color (equivalent tothe color yellow), which is not yet in the seriously low range (whichwould be indicated by the color red on the temperature bar).

FIG. 3B is a screen capture image similar to FIG. 1 illustrating a lowcardiac filling volume indicated by the dark gray color (red) in theheart icon.

FIG. 3C is a screen capture image similar to FIG. 1 illustrating a highcardiac filling volume indicated by the dark gray color (red) in theheart icon.

FIG. 4 is a screen capture image similar to FIG. 1 illustrating a lightgray color (yellow) of the brain icon indicative of a light level ofanesthesia/sedation with low probability of recall, but recall possible.

FIG. 5 is a screen capture image similar to FIG. 1 illustrating a darkgray color (red) of the brain icon indicating that the minimal alveolarconcentration (MAC) for the anesthetic is less than the concentrationexpected to produce amnesia, therefore, the patient could potentiallyhave awareness at this low level of anesthetic.

FIG. 6 is a screen capture image similar to FIG. 1 illustrating threeabnormalities; specifically, the dark gray colored (red) “blood vessels”coming out of the heart icon demonstrate that the blood pressure ishigh; the dark gray color (red) SpO2 in the right lung demonstrates thatthe oxygen level is low; and at the same time the dark gray color (red)of the brain icon illustrates that the anesthetic concentration is low.

FIG. 7 is a screen capture image similar to FIG. 1 illustrating theabnormality of high airway pressures, showing the tracheobronchial treein light gray color (yellow), such that the pressures ventilating thelungs are higher than normal, but not in the dangerous range.

FIG. 8 is a schematic of the real-time visual alert display system ofthe present teachings according to some embodiments.

FIG. 9 is a schematic of the real-time visual alert display system ofthe present teachings according to some embodiments.

FIG. 10 is a schematic of the real-time visual alert display system ofthe present teachings according to some embodiments.

FIG. 11 is a schematic of the real-time visual alert display system ofthe present teachings according to some embodiments.

FIG. 12 is a schematic of the real-time visual alert display system ofthe present teachings illustrating an alert setting forth pertinentlinks to relevant information according to some embodiments.

FIG. 13 is a schematic of the real-time visual alert display system ofthe present teachings according to some embodiments illustrating a bodybased indicia.

FIG. 14 is a schematic of the real-time visual alert display system ofthe present teachings according to some embodiments illustratingmonitoring of skin/body issues.

FIG. 15 is a schematic of the real-time visual alert display system ofthe present teachings according to some embodiments illustratingmonitoring of skin/body issues.

Corresponding reference numerals indicate corresponding parts throughoutthe several views of the drawings.

DETAILED DESCRIPTION

Example embodiments will now be described more fully with reference tothe accompanying drawings. Example embodiments are provided so that thisdisclosure will be thorough, and will fully convey the scope to thosewho are skilled in the art. Numerous specific details are set forth suchas examples of specific components, devices, and methods, to provide athorough understanding of embodiments of the present disclosure. It willbe apparent to those skilled in the art that specific details need notbe employed, that example embodiments may be embodied in many differentforms and that neither should be construed to limit the scope of thedisclosure. In some example embodiments, well-known processes,well-known device structures, and well-known technologies are notdescribed in detail.

The terminology used herein is for the purpose of describing particularexample embodiments only and is not intended to be limiting. As usedherein, the singular forms “a”, “an” and “the” may be intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. The terms “comprises,” “comprising,” “including,” and“having,” are inclusive and therefore specify the presence of statedfeatures, integers, steps, operations, elements, and/or components, butdo not preclude the presence or addition of one or more other features,integers, steps, operations, elements, components, and/or groupsthereof. The method steps, processes, and operations described hereinare not to be construed as necessarily requiring their performance inthe particular order discussed or illustrated, unless specificallyidentified as an order of performance. It is also to be understood thatadditional or alternative steps may be employed.

When an element or layer is referred to as being “on”, “engaged to”,“connected to” or “coupled to” another element or layer, it may bedirectly on, engaged, connected or coupled to the other element orlayer, or intervening elements or layers may be present. In contrast,when an element is referred to as being “directly on,” “directly engagedto”, “directly connected to” or “directly coupled to” another element orlayer, there may be no intervening elements or layers present. Otherwords used to describe the relationship between elements should beinterpreted in a like fashion (e.g., “between” versus “directlybetween,” “adjacent” versus “directly adjacent,” etc.). As used herein,the term “and/or” includes any and all combinations of one or more ofthe associated listed items.

Throughout the present disclosure, the term “patient” is used to referto an individual who is receiving medical care. It should be understood,however, that the term patient does not infer that the individual mustbe located in a hospital (e.g. intensive care unit, operating room,emergency department), doctor office, or other medical center. Theindividual can be located in any location, such as any of theaforementioned locations and additionally in pre-hospital location (e.g.ambulance), extended care facility, nursing facility, home, or othercare facility (both permanent and temporary). Accordingly, suchindividuals, for purposes of the present disclosure, are collectivelyreferred to as a “patient” and such locations, for purposes of thepresent disclosure, are collectively referred to as “care facility”.

Similarly, throughout the present disclosure, the term “caregiver” isused to refer to any individual who is administering or monitoringmedical care of the patient. It should be understood, however, that theterm caregiver should not be infer or interpreted to mean only certifiedmedical caregivers, such as doctors, nurses, clinicians, practitioners,or medical specialists. The term “caregiver”, as used in the presentdisclosure, includes doctors, nurses, clinicians, practitioners, medicalspecialists, and various laypersons responsible for the treatment,monitoring, or medical response of the patient, including non-certifiedmedical attendees (e.g. nursing home employees), family members, andothers responsible for personal medical care of the patient. It shouldbe understood that in some circumstances, the patient may be responsiblefor their own treatment and, thus, are included as a “caregiver”. Forpurposes of the present disclosure, these individuals are collectivelyreferred to as “caregivers”.

General Layout of Screen.

According to the principles of the present teachings, as illustrated inFIGS. 1-10, a real-time visual clinical decision support system 10 isprovided. The real-time visual clinical decision support system 10 cancomprise an alert display device 12 operably coupled to a plurality ofsensors, probes, or other data collecting or monitoring devices 14. Theplurality of sensors 14 can be operable to be coupled to a patient andcollect real-time physiologic data from the patient. Alert displaydevice 12 can comprise a control system or controller separate from orintegrated therewith for assembling data from the plurality of sensors14 for interpretation and/or display on alert display device 12, whichwill be described herein. It should be noted that alert display device12 can comprise one or more display layouts; however, generally, in someembodiments the clinical decision support system 10 comprises one ormore icons, text, graphs, or other display indicia representative of thevital organs and/or major portions of a human body, such as brain, lung,heart, kidneys, liver, and the skin. In some embodiments, the clinicaldecision support system 10 can further comprise one or more icons, text,graphs, or other display indicia representative of other devices orimplantables, such as pacemakers, implantable cardioverter-defibrillator(ICD), neural probes, intercranial pressure monitoring device, trachealtubes, mechanical ventilator, kidney dialysis machines, cardiac bypassmachine, or other device. It should be appreciated that these devices orimplantables can be either passive (e.g. merely monitoring a conditionof the patient) or active (e.g. interacting with a system of the patientto effect a physiological or other response). However, it should beappreciated that additional parameters, organs, drugs, therapies,devices, implantable, or the like could be displayed.

In some embodiments, these icons can be animated such that they move inreal-time with the input of real-time physiologic data from theplurality of sensors 14 or otherwise display or confirm operation of asystem, device, or implantable. For example, the icon used to depict theheart can beat in real-time with the patient's heartbeat provided by thephysiologic monitor and the icon used to depict the lungs can expand andretract (ventilate) in real-time with the physiologic data provided fromthe monitoring system and ventilator (airway pressures). Similarly, theicon used to depict the implantable cardioverter-defibrillator (ICD) canbe animated in real-time, such as through the use of changing size,color, and/or shape, to illustrate operation of the implantablecardioverter-defibrillator. In some embodiments, the icons can be colorcoded to signify the parameters are in various ranges, such as a normalrange being depicted in the color green, a marginal range being depictedin the color yellow, and an abnormal range being depicted in the colorred. Additionally, in some embodiments, additional color depictions canbe used to indicate alert ranges or parameters. For example, in someembodiments, an alert color, such as orange, can be used to highlight anorgan that has risk factors for or a history of organdysfunction/damage. For example, the outline of the heart will be orangeif the patient has a history of heart disease or a history of riskfactors for heart disease. The same is applied to other organ systems,i.e., the brain has a history of a stroke or risk factors for a stroke,the kidneys have a history of renal disease or risk factors for renaldisease such as illustrated in FIG. 9. If a certain drug, medication, ortherapy has been given or is being considered, additional colordepictions or other indicators could show the current estimatedinteraction of that drug with a specific organ or organ system, or inanother embodiment, the potential interaction of a drug and an organcould be depicted to help the caregiver predict the impact of themedical system.

The general layout of the screen is illustrated in FIG. 1, which is ascreen capture of the display, with all systems in the normal range. Ascan be seen, the screen can comprise two or more sections 16 and 18. Thefirst section 16 can comprise pertinent patient history, such as thepatient's name 20, registration number 22, and location, followed byhours NPO 24 (that is, hours since the patient has taken fluids),estimated blood loss 26, and patient's weight 28. The first section 16can further comprise fluid assessments 30 (which will be covered indetail in the Heart Section under Cardiac Fluid) and an alert section32, which in this case informs the provider that there are no glucosemeasurements for this patient or that the glucose needs to be rechecked.Finally, first section 16 can comprise an alert reset button 34. Itshould be noted, as illustrated in FIGS. 9 and 10, in some embodiments,alert section 32 and reset button 34 can be set forth in a dedicatedsection 16′.

In some embodiments, the second section 18 can comprise a series oficons as discussed herein. In some embodiments, the icons can bearranged such that at the top is the brain icon 40 having atracheobronchial tree icon 42 extending there below connected to rightand left lung icons 44, 46. Centrally disposed is a heart icon 48 beingfed from the left by the vena cava 50 and the output aortic arch 52 onthe right going to the body 54 below. The body icon or box 54 cancomprise scales indicating temperature 56, hemoglobin 58, glucose 60,potassium, and INR (International Normalization Ratio). On opposingsides of body 54 can include kidney icons 62.

These icons and/or the overall layout of alert display device 12 aredesigned to be readily identifiable by a layman and/or healthcareprofessional. In some embodiments, real-time physiologic values can beprovided to complement the associated icon. For example, the brain icon40 can comprise a MAC level at 66 on the right which is the minimumalveolar concentration for anesthesia (will be discussed in the brainsection), a BIS (Bispectral index) value at 68 on the left for measuringanesthetic depth. Below in the tracheobronchial tree icon 42, peakairway pressures can be presented along with respiratory rate. Theoutline of the lungs can illustrate the positive end expiratory pressure(PEEP). Additionally, in each lung on the right is oxygenation with SpO2(pulse oximeter arterial oxygen saturation) and on the left is carbondioxide from the end tidal CO2. In the heart icon 48, the level can begreen colored to indicate normal operation. That level in the heart icon48 can go up and down with estimated intravascular volume, which isfilling the heart, i.e. fluid resuscitation status. In some embodiments,the input of information being used to determine that fluid status levelcan be designated 70. This will be discussed in the cardiac section.Below the right lung 44 the systolic and diastolic blood pressure can bepresented at 72. Those values relate to the color of the aortic arch 52on the right of the heart icon 48. A urine output measurement can bedepicted below the right kidney at 74 and, in some embodiments, thepatient's serum creatinine 76 (FIG. 8) can be depicted below the leftkidney. Each of the values within the body 54 are the temperature fromthe physiologic monitor; the hemoglobin/hematocrit either from the labor an estimated value derived from the patient's last hemoglobin value,and blood loss and blood transfusion; and glucose, potassium, and INR,which are derived from the value from the lab.

Moreover, in some embodiments, each of the icons can be illustrated inone or more alert colors, such as green, yellow, red, orange, and thelike. It should be recognized that in some embodiments the icons can beillustrated with one or more alert colors simultaneously, such as anorange alert color at the rear base portion of the brain icon (see FIG.9). Still further, in some embodiments, a graphic or scale, such asscales 56, 58, 60, 68, and the like, can include a highlighted regionsurrounding the scale to bring such scale to the appropriate attentionof a layman and/or healthcare provider (see FIG. 9). It should beappreciated, however, that variations can exist in terms of both color,shape, and/or pattern of these highlighted alerts without departing fromthe present teachings.

Specific Systems and Alerts. Brain

In some embodiments, the brain icon 40 can be colored coded forassessing the level of anesthesia/consciousness. When patients arereceiving anesthetic drugs the level of the anesthetic drug isconstantly calculated by measuring the expired concentration of theinhaled anesthetics (vapor anesthetics: isoflurane, sevoflurane,desflurane, nitrous oxide) and intravenous anesthetics (propofol,dexmedetomidine, midazolam). These anesthetic concentrations come fromthe anesthesia machine's infrared analyzer and the intravenousanesthetics data are provided from the anesthesia information system. Inaddition, these anesthetics derive a term referred to as minimumalveolar concentration for anesthesia (MAC). The estimation of apatient's level or depth of anesthesia is associated with its MAC level.The brain icon 40 will turn colors when the MAC level reaches awake(red), borderline of awake and asleep (yellow), and when the brain isunder anesthesia, that is, >0.6 MAC or the MAC equivalent (green) (seeFIGS. 2, 4, and 5).

As previously described at reference 68, in some embodiments, a columnlabeled Bispectral Index (BIS) (or other similar brain function monitor,e.g. Entropy monitor) can be disposed adjacent brain icon 40. This is anadditional physiologic monitor which is applied on the patient'sforehead and provides information from a processed EEG lead to estimatethe level of anesthesia. The manufacturer of the device and theliterature suggest that a BIS level between 60 and 40 is generalanesthesia, above 60 may be light anesthesia, and between 80 and 100 thepatient is most likely awake or lightly sedated. When this is less than40, it is considered “too deep” of an anesthetic level and the brainicon will turn blue to designate too deep a level. The BIS device isjust an example of this type of EEG based brain activity monitor whichprovides input data to the brain icon.

Similarly, in some embodiments, a real-time calculated MAC value,displayed at reference 66, can be provided. This MAC value, which alsoprovides a method to quantify a level of sedation, can be coupled withthe BIS column to assess the level of anesthesia. Although these levelsfrequently agree, it is often up to the caregiver to determine whichmethod, or the combination of methods, will be used in adjusting theiranesthetic level. During anesthesia, if the MAC level drops to a rangewhere the patient may be aware, the brain icon 40 will change color anda pop-up alert will say “awareness alert.”

There are also risk factors for patients developing stroke in theperioperative period. These risk factors are derived from large studiesof patients undergoing surgical procedures. If the patient has thisconstellation of risk factors, as mentioned herein, a small portion atthe top of the brain icon will be colored orange, indicating thispatient is at risk of perioperative stroke or if the patient has had astroke.

Airway

When patients under anesthesia require mechanical ventilation, anendotracheal tube is placed through the vocal cords into the trachea.That tube is then connected to a mechanical ventilator. This is requiredfor most general anesthetics and whenever a patient requires ventilatorsupport in the ICU. Placing this tube in the trachea is calledendotracheal intubation. Generally, this is done when a patient has beengiven a sedative hypnotic, such as Propofol, and most frequentlyfollowed by a neuromuscular blocking agent, which paralyzes the musclesand enables the anesthesiologist or anesthesia provider or intensivistto intubate the patient with a device called a laryngoscope. Sometimesthis process is difficult due to the anatomy of the patient. There are avariety of predictors of difficult intubation, or difficult airway as itis called, such as recessed chin, immobility of jaw, thick neck, neckwhich cannot flex or extend, poor view of the posterior airway when themouth is open (“mallampati grade”), etc. Knowing these risk factors willcause an anesthesia provider to consider a different method of placingthe endotracheal tube, possibly doing an awake technique calledfiberoptic intubation. Once someone is intubated and is determined to bedifficult, it is very important that future anesthesia care providersare aware of this problem. Not knowing that a patient was a difficultintubation could cause a potential life-threatening event the next timethey are planning to intubate the patient. For this reason an icon 80(FIG. 11) of an endotracheal tube placed in the airway will be coloredorange if the risk factors are present for a potential difficult airway,and it will be red if the patient has a history of a known difficultairway.

Tracheobronchial Tree and Lungs

Below the brain the trachea splits into two, the right and left mainstem bronchi which enter the right and left lung. The right and leftmain stem bronchi will be green when the airway pressures duringmechanical ventilation are in the normal range, turn yellow when theyare slightly elevated, and turn red when they are abnormally elevated(see FIG. 7). All these ranges are configurable. This information isprovided continuously from the ventilator. If the patient has a historyof reactive airway disease (asthma or chronic obstructive pulmonarydisease) which may result in bronchospasm, the outline of the trachea 82(FIG. 11) will be the color orange (signifying potential forbronchospasm).

The right and left lungs are depicted on either side of the heart. Thelungs have an outline which expands and contracts with ventilation, thatis, they expand during inspiration when the pressure goes up ventilatingthe lungs and they retract when the pressure goes down. These data areprovided continuously from the ventilator data and move in real-timewith the patient's breathing. The outline of each lung changes colorwith the level of PEEP. Acute increases in PEEP may represent aventilator malfunction or tension pneumothorax. In the right lung thereis a column 84 (FIG. 10) that shows arterial hemoglobin saturation fromthe pulse oximeter, which is the oxygenation of the arterial blood; inthe left lung is a column 86 (FIG. 10) that shows the carbon dioxidewhich is continuously recorded from the capnometer (the end tidal CO2machine, which is part of the anesthesia machine or a separate monitor).When these values are in the normal range they are both green, when theyare in a marginal range they are yellow, and when they are in theabnormal range they are red. These data are continuously updated to thedisplay. The numerical saturation values are provided below the pulseoximeter column on the right and the numerical value of the expiredcarbon dioxide is provided on the left. When the lungs are ventilated,the digital values for respiratory rate and peak airway pressure areprovided in the upper right. Should the airway pressures acutely riseabove a critical value, an alert will pop-up that says “potential airwayobstruction, bronchospasm” to alert the provider that there are highairway pressures that need to be investigated.

If there are combinations of high inspired peak pressures and highexpired airway pressures, also associated with decreasing bloodpressure, a pop-up alert is provided saying the patient may have a“potential tension pneumothorax” or “potential severe bronchospasm”.This can be a life-threatening situation and occurs when the inspiredand expired ventilator pressures are both acutely elevated inassociation with a decreased blood pressure. This is a situation thatneeds to be investigated immediately.

Lung Fluid

If either lung has certain fluid or other matter present within them,such as with pneumonia or other pulmonary condition, the icon or otherindicia can indicate such condition through a filling level. This canhelp to identify organ-specific diseases that may not be obvious to acaregiver.

Heart

The heart icon 48 which has several functions, including depicting theheartbeat. The heart icon 48 beats (contracts) with the heartbeat of thepatient so there is a real-time assessment of the heart rate.

Cardiac Fluid

There is a level in the heart icon 48 which represents the fillingvolume of the heart or the estimated adequacy of fluid resuscitation ofthe patient. A filling level in the middle of the heart icon 48 isnormal (green), a low level (red), and a high level (red) (see FIGS. 3A,3B, and 3C). That is, there are ranges where the heart does not haveenough fluid (dehydrated) and ranges where the heart is overfull(cardiac failure). The information to calculate this level is providedfrom several aspects depending on the available data. For patients withno invasive monitoring of the heart, the estimate of fluid resuscitationuses standard rules of fluid replacement provided from the literature(generally known is the 4:2:1 rule for obligate fluid loss), also thetime that the patient has been without fluid intake (the NPO time) timesthe obligate fluid loss of a standard patient based on their weight. Inaddition to this, the data from the anesthesia information system areretrieved which provides the amount of fluid the patient has been givenand the type of fluid. That is, whether they have received a crystalloidsolution like normal saline or lactated ringers, or a colloid solutionsuch as albumin, or a blood or a blood product. The calculation alsotakes into account the estimated blood loss which is entered into theanesthesia information system. Therefore, to determine the level offluid resuscitation the system automatically calculates in a balance offluid inputs and outputs to estimate the adequacy of fluid resuscitationduring the procedure.

Because this clinical process of calculating fluid needs is alsodependent on the degree of surgical trauma (sometimes referred to asthird-space losses), the present teachings provide several options forselecting these third-space losses in the first section 16. The threeselections on the third-space losses are to be selected by theanesthesia provider depending on the type of surgical procedure (minorprocedures with little surgical trauma are light, moderate proceduresare moderate, and procedures with large incisions and more tissuemanipulation are severe). Each one of these will automatically use adifferent calculation to determine the needs of fluid during thesurgical procedure (these specific losses for three types of surgicaltrauma are configurable).

All of these inputs are estimates. They are generally accepted ways inwhich caregivers estimate the fluid needed by the patient. They musttake those calculations into account and at the same time the responseof the patient to fluid given with respect to blood pressure, urineoutput and the patient's history of response to fluid volumes. Forexample, patients with a history of congestive heart failure may requireless fluid then others. This is a clinical decision by the anesthesiaprovider. The normalize button 90 allows the provider to “renormalize”the volume icon. That is, if the provider feels that the intravascularvolume of the patient at any point in time is where they want them to bethey can hit the “normalize volume” icon and it will move the icon fluidlevel up to the green level in the middle of the heart and then restarta new calculation from that point in time. If this normalization buttonhas been used a star will be placed beside it to alert other providersand to remind the provider that they have renormalized the volume inthat patient.

In some patients who are undergoing larger procedures or have morepreoperative risk, invasive monitoring catheters are placed tocontinuously measure arterial blood pressure, central venous bloodpressure, or pulmonary artery blood pressure. If an arterial bloodpressure catheter is placed and the providers can measure a variableknown as systolic pressure variation (SPV) (or the similar parameterpulse pressure index, PPI) then the SPV value will be used to determinethe level of cardiac filling and below the heart icon it will state“SPV” for systolic pressure variation and present the last SPV value andthe time it was last measured (or pulse pressure variation, which issimilar to SPV). If the patient has a central venous catheter andcentral venous pressure values are collected from the physiologicmonitor then below the heart icon it will say “CVP” for central venouspressure and use those values to determine high, low, or normal fillingof the heart and the CVP real-time values will be presented. Andfinally, if the patient has a pulmonary artery catheter then data fromthe pulmonary artery diastolic pressure will be presented below theheart and those numbers will be used to determine the adequacy of fluidvolume.

Cardiac Ischemia

Many patients coming to the operating room are older and have a historyof ischemic heart disease or risk factors for ischemic heart disease.Cardiac risk assessment is probably the most important evaluation donepreoperatively to determine the patient's ability to undergo theprocedure and what types of monitoring should be in place during andafter the procedure.

There is significant literature looking at large datasets to determinethe specific preoperative risk factors for having an intraoperative orpostoperative myocardial infarction (heart attack) and more recentlyintraoperative data such as blood pressure and heart rate have beendetermined to increase those risk factors. If the patient haspreoperative risk factors for perioperative myocardial infarction thenthe cardiac outline will be orange. If during the procedure there arechanges in heart rate and blood pressure that would be associated with apostop myocardial infarction which will add to the risk, then a portionof the icon will turn red and a pop-up alert of “potential ischemia”will be presented, FIG. 2. In addition, during surgical procedures or inthe ICU, patients are continually monitored with an EKG. The physiologicmonitors of the EKG can continuously measure changes in the EKGassociated with ischemia of the heart (ST segment changes). If theseischemic ST segment changes are noted during the case then the icon willalso turn red and a pop-up of “possible ischemia” will be presented,FIG. 2.

The intraoperative hemodynamic changes, blood pressure and heart ratewhich are associated with postoperative myocardial infarctions, would beimpractical if not impossible to do in real-time for they are calculatedas a median blood pressure decreases more than 40% from their baselineblood pressure (in the preop area). This type of calculation could notbe done by a caregiver in real-time; therefore this computer allows suchcomplex calculations to happen in real-time on a rolling average toalert for situations that put the patient at risk.

Blood Pressure

On the right side of the heart an aortic arch rises and falls down tothe body. This aortic arch represents the aorta and the real-time bloodpressure. To the right of the blood pressure SBP, which is the systolicblood pressure, presents the current numerical values and diastolicblood pressure. The aorta will change color from green to yellow to redas the blood pressure drops or elevates into abnormal levels, FIG. 6.These levels are configurable for values of SBP, mean arterial pressure(MAP) or percents of the patient's preoperative normal blood pressurevalues. For example, the alert may display (color of the aorta change)when an individual patient's SBP drops below 60% of their preoperativeSBP. It is the standard of care during aesthesia blood pressure bemeasured and documented every five (5) minutes. If blood pressure is notmeasured/recorded in the AIMS for five (5) minutes, the blood pressurenumber and minutes since last blood pressure flash red and alert theanesthesia provider that it needs to be measured.

Predicting Low Blood Pressure

The control system of the present teachings includes an algorithm thatpredicts future low blood pressure. The present device takes the bloodpressure over time and uses that along with the inspired anestheticlevel to predict potential low blood pressure in the immediate future(in the next 3-5 minutes). When potential abnormal blood pressure ispredicted a pop-up alert will be displayed to the provider. Morespecifically, the system monitors changes in SBP. If the predicted SBPin the next time interval (e.g., 4-5 minutes) is predicted (using alinear prediction) to be less than 50 mmHg (configurable), the systemthen looks to see if the inspired anesthetic agent concentration hasdecreased (this decrease in agent concentration shows that theanesthesia provider has noted the decrease in SBP and has taken theappropriate action of decreasing the anesthetic dose). If the inspiredagent concentration has not decreased (meaning appropriate action hasnot been taken), the system alerts to the potential of hypertension. Itshould be understood that this same principle of predicting futurephysiological status, based on the presence or lack of some type ofmedical intervention or event, can apply to additional monitoringsignals, test results, or other measured data.

Body

The rectangle below the heart has several variables being presented. Onthe left is body temperature 56 which comes from the physiologicmonitor, in the center is hematocrit/hemoglobin 88 (FIG. 11) which comesfrom the lab (or an estimate described herein) and on the right is theglucose value 60 which comes from the laboratory. Below the glucose itwill present the numerical value and the time since this measure waslast determined. The same will be done for hematocrit, the time sincethe last measurement will be presented, that is, in minutes, hours anddays. Another column for estimated hematocrit 90 (FIG. 11) will bepresented which estimates the current level of hemoglobin in the bloodusing the patient's initial hemoglobin measurement, the blood loss asretrieved from the anesthesia information system and the fluid given tothe patient, also retrieved from the anesthesia information system.Using literature reported techniques on hemodilution, an estimated levelof hematocrit will be presented to alert the provider at which pointthey may wish to measure a hematocrit to see whether a transfusion mightbe needed. This is an estimate and will be updated whenever ameasurement of the current hematocrit is provided to the system from thelaboratory.

Two additional important lab values are reported: Potassium (K+) 92(FIG. 11) and International Normalization Ratio (INR) 94 (FIG. 11). INRis a test of coagulation/bleeding status. It is used to test thebleeding/clotting ability, specifically for patients taken Warfarin orother drugs effecting bleeding. It is very important to know the INRbefore surgery if the patient has been taking the blood thinners. Thesystem looks in the patient's medication list for Warfarin or otherblood thinners. If present, the INR column is outlined in orange. If INRvalue is available, it will be presented in the INR column, includingnormal/abnormal range.

With particular reference to FIGS. 13-15, in some embodiments, alertdisplay 12 of clinical decision support system 10 can specificallydepict the skin and/or body 130 of the patient. In this way, the skinand/or body condition can be assessed and monitored by a caregiver. Insome embodiments, the front and back of the body can be illustrated toprovide a complete log of skin/body condition. In some embodiments,clinical decision support system 10 enables improved treatment of skinissues in several significant ways. First, by asking a series of basicquestions, it allows someone not skilled in the art of wound managementto stage or evaluate the skin condition correctly. Second, users canemploy clinical decision support system 10 to track and record the skinissue and associated location on the body. Although some caregivers maynot appreciate the influence on certainly skin/body issues on treatmentor care of the patient, clinical decision support system 10 can aid inproviding a system to provide complete monitoring and analysis of manyfactors that influence patient care. Therefore, when integrated into theclinical decision support system, reminders, alerts, or other promptscan help facilitate specific types of care to target specific skinissues, and can also be evaluated alongside any contraindications byleveraging the other available data.

Kidneys

On either side of the body are icons 62 representing the kidneys. Underthe right kidney will be the urine output 100 (FIG. 11), if available,provided in mls, mls/minute and mls/kg of body weight/minute. Thesedifferent measurements of urine flow are of use to the provider. On theleft side below the kidney is the laboratory value of creatinine 76,which is a measure of renal function. These values of creatinine alongwith glucose and hemoglobin are retrieved automatically from thehospital's laboratory system. If the patient's history suggests that thepatient is at risk of postoperative renal failure, then the outer edgeof the kidney icon will be the color orange.

Medical Systems

In some embodiments, various medical systems can be monitored,illustrated, animated, and/or considered in connection with operation ofclinical decision support system 10. Generally, these medical systemsinclude any device or introduced influence that interacts with abiological system of the patient to monitor a condition of the patientor affect a physiological response in the patient. That is, in someembodiments, as set forth herein, the medical systems can comprisevarious medical devices and implantables such as, but not limited to,pacemakers, implantable cardioverter-defibrillators (ICD), neuralprobes, intercranial pressure monitoring devices, tracheal tubes,mechanical ventilators, kidney dialysis machines, cardiac bypassmachines, or other devices that are passive (e.g. merely monitoring acondition of the patient) or active (e.g. interacting with a system ofthe patient to affect a physiological response). Similarly, the medicalsystems can comprise various medications, therapies, or influencingtechnologies such as, but not limited to, drugs, medicines, medications,therapies, protocols, or techniques. These devices or introducedinfluences will collectively and interchangeably be referred to as“medical systems”.

In some embodiments, these medical systems can be monitored, such as viaa medical system detector, to obtain a monitoring signal or other statusrepresentative of the operation of the medical system. It should beunderstood that the medical system detector can comprise a reader ortransmitter for communicating the status of the medical system. Itshould also be understood that the medical system detector can beincorporated into the medical system to be an integral part thereof orcan be a separate device. In some embodiments, the medical systemdetector may be unnecessary if a status signal or operational signal isunnecessary in order to ascertain the status of the medical system. Thismonitoring signal or other status can be considered by the controller toproduce or generate a corresponding display signal based on themonitoring system. Consequently, the display signal can be used toillustrate and/or animate medical system icons 108 (FIGS. 9-11). Thesemedical system icons 108 can be shaped to be readily-identifiablemedical systems by a caregiver, such as, for example, an endotrachealtube icon 80 (FIG. 11) being schematically-shaped as an endotrachealtube. Similarly, an implantable cardioverter-defibrillator (ICD) can beillustrated as an implantable cardioverter-defibrillator (ICD) icon 110(FIG. 11). These medical system icons 108 can be placed or displayednear the organ system with which the medical system is associated. Forexample, an intercranial pressure monitoring device icon can bedisplayed alongside the readily identifiable representation of the brain40. Similarly, a cardiac bypass icon can be place adjacent heart icon 48and a kidney dialysis machine icon can be placed adjacent kidney icon62.

In some embodiments, the relevant associated data, graphs, or otherindicia associated with the medical system can be positioned adjacentmedical system icons 108. Moreover, the operational status of themedical system can be illustrated in association with medical systemicons 108. By way of non-limiting example, if the patient has apacemaker device, operational status of the pacemaker device can beillustrated, such as on, off, error, or other state. These statusdeterminations can be illustrated using an associated color (e.g. green,yellow, red, orange) or other graphic and/or message.

In some embodiments, alert or other messages to a caregiver can beprovided based on the detected, calculated, or otherwise known status ofthe medical system. That is, a secondary parameter can be used to alerta caregiver when the state of the medical system can be varied topromote patient treatment. By way of non-limiting example, an alert canbe given to remind or urge a caregiver to restart a pacemaker after thepacemaker was turned off during a cardiovascular procedure. Conversely,an alert can be given to remind or urge a caregiver to stop a pacemakerprior to initiating a cardiovascular procedure. This alert can ensurethat the medical system is placed in an appropriate condition duringsubsequent treatment.

Alerts, Reminders, and Links to Clinical Documentation

As described herein, in the current practice of medicine there exists alarge body of information, including clinical references, protocols, andguidelines that help to aid a caregiver in the treatment of patients(collectively referred to as clinical documentation). This clinicaldocumentation can include a wide variety of resources, such as journalarticles, presentations, dictionaries, textbooks, clinical references,protocols, guidelines, testing procedures, training materials, technicalmanuals, medical system manuals, trends, clinical analyses, databasequeries and the like.

However, due to the breadth of such clinical documentation, it can bedifficult to quickly obtain such information during time-sensitiveperiods of patient treatment and, thus, the process of obtaining suchinformation may limit the time available for treatment of additionalpatients. To this end, according to some embodiments, clinical decisionsupport system 10 of the present teachings enables automated access toclinical documentation during treatment through on-screen alerts,reminders, and links directly to the relevant clinical documentation. Infact, in some embodiments, the display of such relevant clinicaldocumentation can be prioritized or otherwise sorted according to apredetermined metric, such as, but not limited to, the overall relevancyto the treatment being given, the source from which the relevantclinical documentation was obtained, the time-criticality of thenecessary caregiving response, or other suitable weighting system.

As illustrated in FIG. 12, clinical decision support system 10 cancomprise alert window or other display indicia 116. Alert window 116 candisplay a plurality of clinical documentation associated with adetected, determined, or calculated risk factor or other conditionrelated to patient treatment. In some embodiments, the risk factor canbe detected by any one of the plurality of sensors 14. In some cases,sensor 14 can output a signal indicative of a detected physiologicalcondition of the patient, such as high blood pressure. In other cases,the risk factor can be determined by the controller in response to oneor more detected or known conditions of the patient, medical system orother measured or calculated parameter. Finally, in some cases, the riskfactor can be calculated based on one or more detected or knownconditions of the patient, medical system, or other measured parameters.

Once a risk factor has been detected, determined, or calculated, a riskfactor alert can be displayed using alert window 116. Alert window 116can display one or more clinical documentation(s) 118 related to therisk factor. Specifically, clinical documentation 118 can include anyrelevant clinical reference, protocol and/or guideline relating to thenow-known risk factor or condition.

The alert display system 10 can automatically query a database or otherrepository of references (e.g. Internet) to link to the clinicaldocumentation. In this way, access to clinical documentation can beautomated and provided quickly to a caregiver. In some embodiments, analert, such as alert window 116, or other indicia, such as a warning,icon, or animation, can be used to draw the attention of the caregiverto time critical references. This can aid the caregiver to quickly andefficiently ascertain relevant references to address the risk factor,while reducing associated time and cost necessary to conduct databaseresearch. By way of non-limiting example, clinical documentation can beprovided that relate to kidney or renal management when monitoring apatient having renal failure and/or whom is currently being treated by akidney dialysis medical system.

In some embodiments, a listing of clinical documentations can beproduced upon request by the caregiver in addition to automaticdepiction of references. The request for a listing of clinicaldocumentation relating to a particular organ and/or condition can beproduced by clicking on the related icon on alert display system 10 orother input button. To this end, clicking on the related icon cangenerate alert window 116 containing the relevant clinicaldocumentation.

It should be noted, however, that alert window 116 need not be readilyidentifiable as an organ. That is, a graph or value indicating aspecific lab value or monitor value could tie to an associatedreference. For example, the pain button could include clinicaldocumentation for managing pain as well as trending information on thepatient's pain score. In some embodiments, the clinical documentationcould change depending on the current status of the patient.

In some embodiments, alert window 116 can be generated in response to aparticular organ or medical system being monitored during the course ofpatient treatment. For example, the listing of clinical documentationcould relate to the specific model of pacemaker that is implanted in thepatient. Therefore, clinical documentation 118 can be automaticallyrelated to specific manufacturers, models, statuses of a medical system,or patient procedures.

In some embodiments, alert window 116, and corresponding clinicaldocumentation, can be generated in response to the location of thepatient in the hospital, the specific patient care protocol beingemployed, and/or the specific type of caregiver providing patienttreatment. That is, for example, if a patient is located in an operatingroom, the caregiver may be provided with relevant anesthetic managementdocuments for awareness. If the patient is located in an emergency room,the caregiver may be provided with relevant ischemic stroke documents.Moreover, use of contextual information regarding the patient, thediagnosis, and monitoring data could drive ongoing and dynamicproduction of references.

Basic Types of Rules

In some embodiments, the present teachings, or particularly the presentsoftware, can include various rules requiring input data from variousparts of the patient's electronic medical record; history and physical,home medications, live physiologic data, and anesthesia informationsystem data. Basic Traditional Rules.

The basic system can provide information based on clinical rules ofmanagement that are part of the current training in Anesthesiology. Anexample of such a rule is the rule that determines the filling level ofthe heart. This fluid level in the heart which either shows a low levelin red, a normal level in green, and a high level in red is based on acalculation of fluid inputs and outputs of the patient. The inputs areintravenous fluids of various types, including blood. The outputs areobligate fluid loss due to metabolism and ventilation of vapor, as wellas, blood loss, urine output, and surgical trauma. These rules are basedon published literature from anesthesia textbooks. This type of basicrule as an alert for “Out of Normal Range,” which is based on generaltraining in Anesthesiology, can be configured by the caregiver ifdesired.

Rules Based on Recent Literature which Require Detailed History andPhysical Information.

This second, more complex, rule is based on published literatureregarding risk factors for certain adverse outcomes for the surgicalprocedure, e.g. having a postoperative myocardial infarction (heartattack). The patients come to the operating room with a series ofco-morbidities (other medical diseases) which put them at higher riskfor having a myocardial infarction in the perioperative period, e.g. ahistory of diabetes, history of a previous heart attack, cerebralvascular or renal disease. If a patient has several of these riskfactors they are in a higher risk group and based on publishedliterature this rule in the display system will alert the caregiver ofthe organ at risk. These types of literature are becoming more and moreprevalent as outcomes research has developed more detailed risk analysisbecause of the expanded electronic medical record providing the datasource. Some of these risks are published in the literature but wouldnot be feasible to be calculated in real-time. Those risk analyses notonly include the patient's history, but also current physiologic data,e.g. heart rate and blood pressure. Therefore, a patient would be athigher risk and the system would alert the caregiver that the patient isat higher risk when, for example, the blood pressure has decreased belowthe patient's normal blood pressure value by more than 40% for more than10 minutes. This type of real-time calculation of patient risk would beimpossible to do in the clinical setting while caring for patients.These types of risk analyses are being developed and published in theliterature more frequently, as stated above, with the advent of theelectronic medical record.

Complex Risk Analysis.

The most complex risk analysis can be developed which use largedatabases (>200,000 patients) with large amounts of data to identifypatients at risk. This is done through a complex control systemanalysis. These types of analyses have been done in the manufacturingindustry for quality control of products. This type of complexstatistical engineering analysis is being applied to the perioperativeand critical care data to derive complex algorithms which predict thepotential of adverse outcomes and therefore can alert caregivers inadvance to enable earlier diagnosis and treatment of potential adverseevents.

Alternative Uses

In some embodiments, the present teachings can be used for the detectionof the disease Malignant Hyperthermia and Malignant Neuroleptic Syndromeduring anesthesia.

Specifically, by way of background, Malignant Hyperthermia is a rare,but life-threatening disease that occurs under general anesthesia when apatient is exposed to the muscle relaxant succinylcholine and/or apotent halogenated vapor anesthetic, e.g. isoflurane, sevoflurane,desflurane. This is a genetic disorder which is autosomal dominant witha mixed penetrance that involves an abnormality of the ryanodinereceptor in the muscle. It causes uncontrolled release of calcium andresults in a severe metabolic crisis. Malignant Neuroleptic Syndrome hasthe same clinical signs, symptoms, and treatment. It also occurs underanesthesia.

The present teachings use the simultaneous collection of data fromanesthesia machine and an anesthesia information system and monitors toidentify the onset of malignant hyperthermia to allow early detectionand treatment. If treated early with the drug Dantrolene the disease hasa very good outcome. The present teachings, in some embodiments,requires electronic data from an anesthesia machine, more specifically,end expired carbon dioxide measurements, inspired carbon dioxidemeasurements, minute ventilation (respiratory volume times respiratoryrate), and with or without the patient's weight.

In some embodiments, if the following calculated events occur, MalignantHyperthermia alert will be activated:

End expired carbon dioxide increases at a rate greater than 1.5mmHg/min. (which is configurable) while, simultaneously the minuteventilation (expired tidal volume×respiratory rate) remains at 80% ofthe normal level (80 cc/kg/min. (which is configurable)) or greater and,the inspired carbon dioxide level remains less than 2 mmHg* and is notincreasing.

With all three of these events happening simultaneously for more than 10minutes or other predetermined time period, then Malignant Hyperthermiaor Malignant Neuroleptic Syndrome is diagnosed.

It should be appreciated that these numeric thresholds and/or conditionscan be configurable and/or eliminated in some embodiments.

In some embodiments, a diagnosis of Malignant Hyperthermia can bediagnosed when the end expired CO2 is rising steadily in the presence ofno increase in inspired CO₂ and a normal minute ventilation. If all ofthese three events occur during anesthesia, it is diagnostic ofMalignant Hyperthermia.

In some embodiments, the present teachings can be used for the detectionof Tension Pneumothorax.

Specifically, by way of background, a tension pneumothorax is an acutehemodynamic emergency where the air is trapped in a thoracic cavityproducing high pressure which prevents blood from returning to the chestand right heart causing a life-threatening reduction in cardiac bloodflow and blood pressure. This only occurs in patients receiving positivepressure ventilation either during anesthesia in the operating room orbeing ventilated in intensive care or other ventilator unit. For thisalarm to be utilized it requires electronic capture of blood pressuredata and inspired and end expired pressure ventilator data. These dataare available when there are anesthesia information systems or criticalcare information systems in place.

In some embodiments, the present teachings use the simultaneouscollection of data to detect the occurrence of three events diagnosticof a Tension Pneumothorax:

Elevated peek airway pressures by the ventilator greater than 40 mmHg(which is configurable) and increasing.

Elevated end expired ventilator pressures greater than 15 mmHg (which isconfigurable) and increasing.

Decreasing arterial blood pressure less than 70 mmHg.

It should be appreciated that these numeric thresholds and/or conditionscan be configurable and/or eliminated in some embodiments. It should benoted that variations in display parameters, indicia, and thresholdvalues are configurable. The present teachings can be used beyond theenumerated embodiment.

In each of the foregoing examples, it should be appreciated that withoutthe simplified monitoring and display capabilities of the presentteachings, it may be difficult for a caregiver or healthcare provider toassembly such information to provide a quick and reliable diagnosis ofsuch rare diseases.

The foregoing description of the embodiments has been provided forpurposes of illustration and description. It is not intended to beexhaustive or to limit the invention. Individual elements or features ofa particular embodiment are generally not limited to that particularembodiment, but, where applicable, are interchangeable and can be usedin a selected embodiment, even if not specifically shown or described.The same may also be varied in many ways. Such variations are not to beregarded as a departure from the invention, and all such modificationsare intended to be included within the scope of the invention.

What is claimed is:
 1. A clinical decision support system for patienttreatment comprising: a monitoring system operably coupled to a patient,said monitoring system passively engaging with the patient, saidmonitoring system outputting a first monitoring signal in response to ameasured parameter of the patient, said monitoring system furtheroperably coupled to a medical system associated with the patient, themedical system actively engaging with the patient to effect aphysiological response in the patient, said monitoring system outputtinga second monitoring signal in response to a detected condition of themedical system; a controller receiving said first and second monitoringsignals and continuously calculating a secondary, non-measurableparameter of the patient based on said measured parameter, saidcontroller outputting a display signal; and a display device operablycoupled to said controller and receiving said display signal, saiddisplay device having a plurality of display indicia where at least oneof the plurality of display indicia is responsive to said displaysignal, wherein at least one of said plurality of display indicia beingsubstantially shaped as a readily-identifiable organ and operable toactively display a condition indicative of an associated organ of thepatient.
 2. The clinical decision support system according to claim 1wherein at least one of said plurality of display indicia issubstantially shaped as a readily-identifiable medical system andoperable to actively display a condition indicative of the medicalsystem operably coupled to the patient.
 3. The clinical decision supportsystem according to claim 2 wherein said condition indicative of themedical system is an operational state condition.
 4. The clinicaldecision support system according to claim 1 wherein said controllerdetermines said display signal based on an automated calculation,whereby said controller actively accesses a medical-related history ofthe patient derived from an electronic source other than said monitoringsignal to determine said automated calculation.
 5. The clinical decisionsupport system according to claim 1 wherein each of said plurality ofdisplay indicia is selectively dynamically animated to illustrate areal-time condition indicative of the medical system in response to thesecond monitoring signal.
 6. The clinical decision support systemaccording to claim 1 wherein each of said plurality of display indiciais selectively dynamically animated to illustrate an incorrect conditionindicative of the medical system in response to the second monitoringsignal.
 7. The clinical decision support system according to claim 1wherein at least one of said plurality of display indicia is an alertindicative of a heightened risk associate with the medical system. 8.The clinical decision support system according to claim 1 wherein saidcontroller actively accesses a medical-related history of the patientderived from an electronic source other than said monitoring signal todetermine said heightened risk associated with the medical system. 9.The clinical decision support system according to claim 1 wherein saidcontroller actively accesses a medical-related history of the patientderived from an electronic source other than said monitoring signal todetermine the presence of the medical system.
 10. The clinical decisionsupport system according to claim 1 wherein said at least two of saidplurality of display indicia are chosen from a group consisting of aheart, brain, lung, body, kidney, liver, and skin.
 11. The clinicaldecision support system according to claim 1 wherein said secondary,non-measurable parameter of the patient is a heart filling level. 12.The clinical decision support system according to claim 1 wherein saidsecondary, non-measurable parameter of the patient is an input and anoutput of the patient's heart.
 13. The clinical decision support systemaccording to claim 1 wherein said controller determines said displaysignal in response to a predetermined risk factor, said predeterminedrisk factor being based on known literature effects.
 14. The clinicaldecision support system according to claim 1 wherein said controllerdetermines a patient-based baseline value for at least one of saidmeasured parameter and said second, non-measurable parameter, saidcontroller outputting an alert via said display signal when a subsequentmeasured parameter exceeds a predetermined range based on saidpatient-based baseline value.
 15. The clinical decision support systemaccording to claim 1 wherein said controller determines a possibility ofcomplications based on accumulation of risk factors and said measuredparameter.
 16. A clinical decision support system for patient treatmentcomprising: a monitoring system operably coupled to a patient, saidmonitoring system passively engaging with the patient, said monitoringsystem outputting a first monitoring signal in response to a measuredparameter of the patient, said monitoring system further operablycoupled to a medical system associated with the patient, the medicalsystem actively engaging with the patient to effect a physiologicalresponse in the patient, said monitoring system outputting a secondmonitoring signal in response to a detected condition of the medicalsystem; a controller receiving said first and second monitoring signalsand continuously calculating a secondary, non-measurable parameter ofthe patient based on said measured parameter, said controller outputtinga display signal, said controller actively accesses a medical-relatedhistory of the patient derived from an electronic source other than saidmonitoring signal to determine the presence of the medical system; and adisplay device operably coupled to said controller and receiving saiddisplay signal, said display device having a plurality of displayindicia where at least one of the plurality of display indicia isresponsive to said display signal, wherein at least one of saidplurality of display indicia being substantially shaped as areadily-identifiable organ and operable to actively display a conditionindicative of an associated organ of the patient and at least one ofsaid plurality of display indicia is substantially shaped as areadily-identifiable medical system and operable to actively display acondition indicative of the medical system operably coupled to thepatient.
 17. The clinical decision support system according to claim 16wherein said controller determines said display signal based on anautomated calculation, whereby said controller actively accesses amedical-related history of the patient derived from an electronic sourceother than said monitoring signal to determine said automatedcalculation.
 18. The clinical decision support system according to claim16 wherein each of said plurality of display indicia is selectivelydynamically animated to illustrate a real-time condition indicative ofthe medical system in response to the second monitoring signal.
 19. Theclinical decision support system according to claim 16 wherein saidcontroller actively accesses a medical-related history of the patientderived from an electronic source other than said monitoring signal todetermine said heightened risk associated with the medical system.
 20. Aclinical decision support system for patient treatment comprising: amonitoring system operably coupled to a patient, said monitoring systempassively engaging with the patient, said monitoring system outputting amonitoring signal in response to a measured parameter of the patient; acontroller receiving said monitoring signal and also receiving orcalculating a non-measured value for a medical system associated withthe patient, the medical system actively engaging with the patient toeffect a physiological response in the patient; and a display deviceoperably coupled to said controller and receiving a plurality of displaysignals, said display device having a plurality of display indicia whereat least one of the plurality of display indicia is responsive to saidmonitoring display signal, and where at least one of the plurality ofdisplay indicia is responsive to said medical system display signal.